J. A. Raton

Contact dermatitis from propolis

adhesive tape which was used when the patient was patch tested with the routine series and with the new cutting fluids after the summer (3). It is impossible to assess whether the sensitization to diphenylthiourea is due to the application of the compound in the routine series or to the adhesive tape. The patient was probably sensitized to diphenylthiourea through the patch testing procedure, as she did not use any adhesive tape in the interval between the tests. The results of re-testing 379 hand eczema patients with II substances first applied 6-21 months previously have been reported ( 4). 19% of the tests had become positive, but no testing was performed with dilutions. Therefore, some of the positive reactions may represent a higher sensitivity in previouslysensitized individuals. Diaminodiphenylmethane was one of the compounds giving a statistically significant change. The concentration used in this investigation was 2%, while the concentration of diaminodiphenylmethane in the present routine series is 0.5% (w/w). The crucial importance of the test concentration has been demonstrated (5). More subjects were sensitized by 8% para-phenylenediamine than by 2% when the same vehicle was used. Tetramethylthiuram disulphide ( 1%) sensitization by patch testing has been reported to be the most common ( 6). The present patient was sensitized to tetramethylthiuram monosulphide ( 1.5% w I w) and did not react to tetramethylthiuram disulphide at the same concentration. The reported case with patch test sensitization to 3, probably 4 substances in a routine test series is an example of possible adverse reaction to patch testing. The 4 compounds were chemically unrelated, so cross-reactivity is excluded. Patch test sensitization may be more common than expected, but sensitization to 3 compounds, shown by simultaneous flare-up reactions, is probably very rare. It is surprising that the patient with this disposition to patch test sensitization was not sensitized to substances in her environment, although she had a hand dermatitis.

Greater allergenicity of topical ketoprofen in contact dermatitis confirmed by use

The use of topical non‐steroidal anti‐inflammatory drugs (NSAIDs) is very popular in spite of their doubtful efficacy and high number of generally not serious, but preventable, adverse effects, especially photoallergy. The allergenic potential of different topical NSAIDs was determined by performing a retrospective observational study of the period 1996–2001 and comparing the cases of allergy and photoallergy with the use of each topical NSAID. The diagnoses were obtained from a review of the clinical records of patch/photopatch testing carried out in the dermatology departments of 2 public hospitals in Bizkaia (Spain). The use of the different topical NSAIDs was obtained from invoices sent to the National Health System and the Reporting odds ratio (ROR) and Proportional reporting ratio (PRR) disproportionality estimates of the FEDRA database of the Spanish Pharmacovigilance System. A total of 139 contact reactions to topical NSAIDs were found with ketoprofen being responsible for 28% of the allergies and 82% of the contact photoallergies in spite of not being the most used topical NSAID (third in the ranking, diclofenac was the first). The ROR for ketoprofen was 3.9 (2.4–6.4) and the PRR 3.4 (2.1–5.5), thus confirming the possibility of a warning signal. The results support the need for regulatory action on topical ketoprofen.

Erupción acneiforme por inhibidores del receptor de crecimiento epidérmico

One of the fundamental aims of oncological research is the search for molecules with greater efficacy against tumors and less toxicity than the usual chemotherapeutic agents. Epidermal growth factor receptor inhibitors are a new group of drugs which, because of their more specific effect against neoplastic cells, seem to meet these characteristics. Skin eruptions are one of the most frequent adverse effects associated with their use, secondary to the drugs direct inhibitory effect on homeostasis of the epidermis and of the pilosebaceous follicle. Several cases of cutaneous toxicity in patients treated with epidermal growth factor receptor inhibitors have recently been published. We present three cases of acneiform eruptions attributable to different drugs in this family (cetuximab, gefitinib and erlotinib).

Disseminated Bacillus Calmette-Guerin Infection in an HIV-Infected Child: A Case with Cutaneous Lesions

Abstract: A boy bom to a mother with unknown HIV infection was immunized with BCG In his first month of life. Seven months later axillary adenopathy developed. At the age of 10 months, 2 months after HIV Infection had been diagnosed, papular skin lesions appeared all over his body. Mycobacterium bovis, BCG strain, was cultured from a lymph node and blood. Ziehl‐Neelsen stain of a skin biopsy specimen showed histiocytes loaded with numerous acid‐fast bacilli. The patient died 10 days later, before the infection was confirmed. This is the first reported case of disseminated BCG infection in an HIV‐infected child presenting with cutaneous lesions.

Successful treatment of musk ketone-induced chronic actinic dermatitis with cyclosporine and PUVA

We describe a patient with chronic actinic dermatitis whose photopatch tests revealed reactions to musk ketone and musk ambrette, both of which were found in his aftershave lotion. Minimal erythema doses of UVA and UVB were decreased. After initial unsuccessful treatment with PUVA therapy the patient was successfully treated with a combination of cyclosporine and PUVA.

Dermatitis due to mitomycin C bladder instillations: study of 2 cases

temperatures reached when candles were burning. In a spacious cathedral with an everyday deployment of many hundred candles, the level of atmospheric benzoyl peroxide was evidently enough to elicit dermatitis in a highly sensitive person regularly exposed as a sacristan. A positive patch test to benzoyl peroxide was obtained at 0.5%, low enough to rule out an irritant reaction (9). The eczema on the trunk was interpreted as secondary spread. The patient himself did not appear to be atopic. Benzoyl peroxide can now be added to the list of causes of airborne contact dermatoses (10).

Focal dermal hypoplasia (Goltz syndrome): An adult case with multisystemic involvement

Focal dermal hypoplasia (Goltz syndrome) is a rare congenital syndrome with suspected X-linked transmission that is characterized by a wide range of mesoectodermal defects. We describe a 39-year-old woman who had a peculiar phenotype and asymmetry of the body. Examination revealed atrophic erythematous and hyperpigmented linear streaks following Blaschkos lines, some of which were in a reticular or cribriform arrangement. Yellow, soft nodules caused by fat herniation were visible mainly in skin folds. The patient had multiple bone anomalies, including longitudinal striation of long bones (osteopathia striata). She had several ocular, dental, and kidney defects. Histopathologic examination showed a markedly thinned dermis that was replaced by adipose tissue.

MULTIPLE ANGIOKERATOMAS WITH ZOSTERIFORM DISTRIBUTION IN TWO SISTERS

Case 1: At the age of 12 years a 28 year‐old woman noticed multiple reddish papular lesions on the left buttock and thigh. The lesions gradually spread to involve her left thigh towards the knee. The patient had no systemic symptoms, Examination of the skin revealed 23 well‐circumscribed, purplish verrucous lesions each of 2–3 mm diameter, located over the left buttock and extending in a linear fashion to the popliteal flexure (Fig. 1). General examination and routine laboratory studies were normal.

Occupational allergic contact dermatitis caused by N,N-didecyl-N-methyl-poly(oxyethyl) ammonium propionate in a dental assistant

N,N-didecyl-N-methyl-poly(oxyethyl) ammonium propionate is a quaternary ammonium compound that is used to disinfect medical devices. Occupational allergic contact dermatitis caused by quaternary ammonium compounds in healthcare workers is an increasingly important issue (1). We report a case of severe allergic contact dermatitis caused by N,N-didecyl-N-methyl-poly(oxyethyl) ammonium propionate after occupational exposure, which seems to be very uncommon.

Positive patch tests to zinc pyrithione

negative reactions are obtained in unaffected skin (I 2-16). Scratch tests and intracutaneous tests have been found to yield similar results to patch tests (17-19). Recently, Lee & Lee (8) reported a positive lesional patch test with chlormezanone. In our case, scratch testing with a combined medicament (chlormezanone plus paracetamol) in Iesional skin remained negative; however, there was a flare-up ofFDE after oral intake of pure chlormezanone. No systemic reactions were observed.